Missed or delayed diagnoses in the emergency department (ED) are the leading cause of malpractice liability in Emergency Medicine. In 2010, CRICO and CRICO Strategies convened the Emergency Medicine Leadership Council (EMLC) to address this challenge. Applying comparative malpractice data and their own experience and expertise, the EMLC participants (including representatives from the Harvard-affiliated hospitals and CRICO Strategies client organizations) worked to identify the underlying factors that contribute to missed or delayed diagnoses, and patient adverse events, in the ED. While diagnosis-related missteps are often attributed to cognitive error on the part of the physician, the group identified communication problems and information gaps as present in many of the malpractice cases. After reaching a consensus that optimal physician-nurse communication at critical junctures in ED care is one key to reducing diagnosis-related errors, each participating organization field-tested one or more communication improvement strategies. Based on feedback from those short-term activities, CRICO has compiled best practices to inform recommendations for optimizing physician nurse communication in the ED. The insights and recommendations of the EMLC are presented in this paper.

Top 5 Ways to Enhance RN-MD Communication in the Emergency Department

  • Set specific physiologic parameters that trigger an alert to both the nurse and physician
  • Physician-Nurse huddles at regularly scheduled intervals during the shift
  • Discharge timeout involving both the physician and nurse
  • Routine reconciliation of abnormal vital signs
  • Directly observe communication patterns to identify areas of improvement
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